Timing of renal-replacement therapy in patients with acute kidney injury and sepsis

Severe acute kidney injury is an independent risk factor for death in the setting of septic shock, even after renal-replacement therapy to treat the damage. Researchers in France, however, wondered if whether time to initiation of dialysis plays a role in mortality.

Severe acute kidney injury is an independent risk factor for death in the setting of septic shock, even after renal-replacement therapy to treat the damage. Researchers in France, however, wondered if whether time to initiation of dialysis plays a role in mortality. To investigate further, they conducted a multisite trial that included 477 patients in the final analysis. Participants were all in the "failure" stage of the RIFLE (risk, injury, failure, loss, and end-stage) kidney disease classification system and were in the early stages of septic shock. Each was randomly allocated to undergo renal-replacement therapy within 12 hours of acute kidney injury or after 48 hours in the absence of renal recovery. The primary endpoint was 90-day mortality, which occurred at a rate of 58% among the patients who received renal-replacement therapy early vs. 54% among the patients who received delayed treatment. The difference was not considered to be statistically significant, leading researchers to conclude that early dialysis does not improve mortality rates at 90 days vs. delayed dialysis.